Complete this form to report a discrimination complaint. (Customers should complete the form whenever possible.To file a formal complaint, please submit a written or online Title VI Complaint Form. Provide as much information as possible, including: (1) the date(s), (2) location(s),(3) what happened, and (4) contact information for any witnesses. A blank form you can use to write out your petition is attached. Also attached is a sample that may be used as a guide. If you have been subjected to unlawful discrimination, harassment, or retaliation, please complete and submit a complaint form. Describe the nature of the action, decision, or conditions of the alleged discrimination. (Attach additional pages to this form as necessary). Complaints Alleging Discrimination in the Workplace (Model Procedures) on Page 2 of this form.